“It is very, very upsetting for people to suddenly lose a drug they’ve come to rely on. In conditions like high blood pressure, but also in conditions like epilepsy or arthritis, these are problems that sometimes take a long time to stabilize.”

– Dr. Jacalyn Duffin (Queen’s University, Kingston, Ont.)

Besides adverse effects on their health, these shortages may cause many “snowbirds” to be grounded.

In the upcoming federal election, Canadians will likely care less about the ethical issues in the SNC-Lavalin affair, and more about jobs, personal finances, and even how to cope with the return of winter. Many people will be making plans for their winter vacation.

Each fall, a number of patients come to my office to fine-tune their medications. Often, when I am about to increase the dose or add a new medication for better control of diabetes mellitus, hypertension, etc., patients will remark that they are planning to leave for Florida, take a cruise or go to other out-of-country destinations in a month or two.

Even a change in dose of medications within three months of travelling could invalidate private travel insurance, and certainly a change to a “close-cousin” in the same family would do so. I usually simply advise them to adhere more strictly to dietary restrictions until they return to Canada. Now a larger group of persons – those who have been stable for years on various medications – face possible loss of insurability.

For many months, well-established drugs have been suddenly placed on “backorder” for an unknown period of time. This involves drugs used in cancer therapy as well as several for hypertension, heart failure, diabetes mellitus, heartburn, and seizures.

On her website, Dr. Duffin lists 16 possible causes. These include increased global demand, a lack of active ingredients, contamination issues, vague manufacturing problems or simply a decision to stop making an unprofitable drug. Health Canada reports that there are currently 1,848 drug shortages. The problem is global, and affects over 100 countries.

Yet Duffin asserts, “Canada should be standing up and leading the world in investigation to figure it out.” It does not appear to be doing so.

A forced change in medications within three months of travelling can be economically disastrous if it makes patients “unstable” in the eyes of insurance companies. Unfortunately, few Canadians can instead rely on coverage by their provincial governments, even though it is required by federal law.

The Canada Health Act Annual Report 2017-18, states the following: “If insured persons are temporarily out of the country, insured services are to be paid at the home province’s rate.”

Of interest is that, buried in the report, is this correct statement: “For all jurisdictions except Prince Edward Island and the three territories, the per diem rate for out-of-country services appears lower than the home province or territory rate, which is contrary to the requirement of portability criterion of the CHA.”

Sadly, whereas financial penalties for violations of extra-billing and user fees are “mandatory,” those for other violations such as portability are only “discretionary.” The report continues: “To date the discretionary penalty provisions of the Act have not been applied.” Nova Scotia and most provinces have adopted the attitude that people should simply purchase private travel insurance. But this will become increasingly difficult for many.

All Canadians — but especially those planning to leave the country on business or vacation — should demand that the federal health minister investigate the cause of worsening drug shortages and find solutions.

In addition, after many years of federal inaction, she should finally ensure that all Canadians receive at least the health coverage outside their country that is clearly required by the Canada Health Act. This will likely provoke demand by the provinces for increased federal health transfer payments. Therefore, when the federal, provincial, and territorial health ministers next meet, updating and amending the CHA should be on the agenda so as to make health delivery more fiscally sustainable.

By the Oct. 21 election, the SNC-Lavalin affair, Justin Trudeau’s pledges to balance the federal budget, change the method of voting, and not use omnibus bills will likely be far less important to most Canadians than health issues. The problems described above will become increasingly relevant as winter approaches and quite likely even more drugs will be suddenly placed on backorder.

In this “Catch-22” situation, many Canadians will face being deprived of spending a few weeks in the sun purely due to lack of adequate government or private health coverage outside their country. Politicians should recall that a high percentage of these older persons do vote.

Dr. Charles S. Shaver was born in Montreal. He is past-chair of the section on general internal medicine of the Ontario Medical Association. The views expressed here are his own.